Diabetic neuropathy

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Diabetes Metab. 2001 Apr;27(2 Pt 1):155-8.

An unusual neuropathy in a diabetic patient: evidence for intravenous immunoglobin-induced effective therapy.

Romedenne P,.
We report the case of a 68-year old type-2 diabetic male patient who was admitted to hospital for progressive weakness in the right lower limb. Although his metabolic control was good, he lost more than 20 kg of weight. Despite intensive physio- and vitaminotherapy, his neurological condition kept on degrading with a severe amyotrophy and pain of the right thigh. He was unable to walk and to stand alone. Besides a yet known sensitive polyneuropathy, the electrophysiological study signs of demyelination and axonal degeneration. Combined with the albuminocytologic dissociation observed in the cerebrospinal fluid, a diagnosis of inflammatory neuropathy was diagnosed. The patient underwent a treatment by methylprednisolone andwith immunoglobins a striking improvement of his neurological condition. This case report illustrates that rare forms of neuropathy such as inflammatory neuropathies close to chronic inflammatory demyelinating polyneuropathy (CIDP) can occur in diabetic patients and superimpose on the more commonly described forms of neuropathies. It recalls the importance of inflammatory neuropathies are perfectly curable.

The spectrum of CIDP.
Rotta FT, Sussman AT, Bradley
Department of Neurology, University of Miami School of Medicine,
Research criteria for the diagnosis of chronic inflammatory demyelinating polyneuropathy (CIDP) were proposed by committee of the American Academy of Neurology (AAN) in 1991, and since then these criteria have been widely used in clinical studies. We have been impressed by the frequent finding of electrophysiological changes of a demyelinating neuropathy in patients whose clinical presentation does not conform to the usually accepted clinical phenotype of CIDP. In our study  the clinical spectrum of CIDP,  Forty-seven patients (54%) had distinct features outside the usual clinical presentation of CIDP. Of these, 15 (17%) had predominantly distal features, 13 (15%) had exclusively sensory polyneuropathy; seven (8%) had markedly asymmetric disease, seven (8%) had associated CNS demyelination, four (5%) had predominant cranial nerve involvement, and one (1%) had only the restless legs syndrome.  Associated medical condition that may have been responsible in acquired demyelinating neuropathy was present in 60% of the patients. We conclude that spectrum of CIDP is broader than would be indicated by the strict application of the AAN research criteria, and that many of the cases meeting more liberal criteria frequently respond to immunosuppressive therapy.Please continue to next page of variants

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